Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-4354
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CANONIC (SENIOR DIRECTOR, ENROLLMENT)
(480) 853-0515
Entity
Organization
Contact information
Practice address
5010 AIRPORT PULLING RD N, NAPLES, FL 34105-2407
(239) 213-3359
(479) 277-4331
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22598
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031980500
—
FL
05
—
031980501
—
FL
01
—
2008647
PK
—
Enumeration date
03/14/2007
Last updated
07/09/2025
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